Intro to Critical Care - Block 4

Question 1

What types of acute organ dysfunction fall under ICU?

Answer 1

1. Shock
2. Sepsis
3. ADHF
4. Acute tox
5. Status epilepticus
6. Stroke
7. End organ damage from chronic dx

Question 2

Who are closely monitoring the ICU?

Answer 2

1. Trauma
2. High risk surgeries (CABG, neurosurgical)
3. High risk bleeding

Question 3

What are the phases of crit illness?

Answer 3

1. Rescue
2. Optimization
3. Stabilization
4. De-escalation (step-down)

Question 4

Route of med most common in ICU?

Answer 4

IV route:
1. Predicatable F
2. Fast onset
3. Rapid titratability
4. Wide therapeutic window

Question 5

How is absorption affected in crit patients?

Answer 5

1. Perfusion deficits
2. Dysmotility
3. Altered pH
4. Loss in bowel integrity (perforation)
5. Peripheral/gut edema
6. Regional blood flow

Question 6

Changes in Vd is affected by?

Answer 6

1. FLuid shifts
2. Tissue perfusion
3. PPB
4. Reduced tissue perfusion decreases distribution of hydrophilic medications
5. Lipophilic (lipid-soluble) medications penetrate well into tissues independent of blood flow

Question 7

What is shock liver?

Answer 7

Hypoxic hepatitis:
1. Acute cardiopulmonary failure
2. Transient increase in serum aspartate or alanine aminotransferase
3. Exclusion of other etiologies

Question 8

When is augemented renal clearance used?

Answer 8

CrCl >120-160

Question 9

How is distribution affected in crit patients?

Answer 9

1. Largevolume resuscitation
2. Capillary leak syndrome
3. Ascites
4. Mechanical ventilation
5. Hypoalbuminemia
6. ECMA
7. Decreased a1 acid glycoprotein

Question 10

How is metabolism affected in crit?

Answer 10

1. Hepatic enzyme induction
2. Augmented hepatic blood flow
3. Hepatic enzyme inhibition
4. Decreased hepatic blood flow

Question 11

How is excretion affected by crit?

Answer 11

1. Augmented renal clearance
2. Extracorporeal removal
3. AKI

Question 12

What is MODS?

Answer 12

Potentially reversible physiologic derangement involving 2 or more organ systems not involved in disoder that resulted in ICU

Question 13

What are you vital organs for survival?

Answer 13

Brain, kidney, heart, lung, liver

Question 14

How do you interpret MOD score?

Answer 14

↑ MOD -> ↑ organ damage and mortality
MOD score of 0 is the best, 4 is the worst

Question 15

How do you calculate R/P ratio?

Answer 15

(HR x right atrial pressure)/MAP

Question 16

CV MODS description?

Answer 16

1. Decreased peripheral vascular tone
2. Increase capillary permeability 0> edema
3. ALteration in regional bloof flow
4. Microvascular plugging and stasis
5. Myocardial depression

Question 17

Lung mods description?

Answer 17

Failure of normal gas exchange

Question 18

Kidney mods description?

Answer 18

Impariment in excretion

Question 19

Immunologic MODS description?

Answer 19

nosocomial ICU-acquired infection

Question 20

Prevention of MODs in lungs?

Answer 20

Ventilation

Question 21

Prevetnion of MODS in CV?

Answer 21

Restrict transfusion of packed red cells when hemoglobin is > 70

Question 22

MOD prevention in renal?

Answer 22

Avoidance of nephrotoxins

Question 23

Prevetnion of MODS in GI?

Answer 23

Stress ulcer prophylaxis with H2 blockers rather than sucralfate

Enteral nutrition

Question 24

MOD prevention in hematologic?

Answer 24

DVT prophylaxis

Question 25

What are inhaled meds for respiration? Advantages?

Answer 25

Bronchodilators (Combivent - Ipratropium/Albuterol), steroid, abx 1. Rapid onset 2. high lung tissue drug concentrations 3. Limited tox 4. No IV

Question 26

What is you most invasive way of delivering O2 to a patient?

Answer 26

Ventilation

Question 27

What is the sequence ofdrug in rapid sequence intubation?

Answer 27

1. Sedative always goes first 2. Neuromuscular blockers as a paralysis agent

Question 28

What are ex of continuous organ support?

Answer 28

Establishes a new steady state: 1. CRRT 2. ECMA

Question 29

What is an ex of intermittent organ support?

Answer 29

Changes medication dispostiton and elimination: 1. HD 2. TPE 3. ELSS

Question 30

What is ECMO?

Answer 30

Bypasses lungs: Deoxygenated blood is brained from the superior vena cava, pumped through and oxygenator, and delivered back into the body through the femoral artery

Question 31

What is TPE?

Answer 31

Plasma exchange that is a closed-circuit blood purification system that removes large molecules

Question 32

How are medications affected by TPE?

Answer 32

Alters the volume of distribution, protein binding, and clearance of a medication: 1. Human albumin replacement can increase the fraction of protein-bound medications 2. Removes drugs present in plasma

Question 33

What is ELSS?

Answer 33

Extracorporeal Liver Support System: dialysis for failing liver -> allow hepatocytes to recover or temporize until liver tranplants

Question 34

What are the components of an ICU check up?

Answer 34

Feeding ANalgesia Sedation Thromboembolism prevention Head of the bed elevation Ulcer prophylaxis Glucose control Spontaneous breathing trial Bowel function evaluation Indwelling catheters (removal) De-escalation of antimicrobial and other pharm

Question 35

What is PICS?

Answer 35

Post intensive care syndrome: complication of ICU surviorship where assessment is recommended within 2-4 weeks of discharge